title: Predictors of recurrence in intraductal papillary mucinous neoplasm: experience with 183 pancreatic resections.
abstract: OBJECTIVE
  We examined long-term outcomes in patients with surgically treated intraductal papillary mucinous neoplasm (IPMN) to determine if any clinical or histologic features could predict risk of recurrent disease.
  
  
  METHODS
  We reviewed 183 margin-negative surgical resections performed for IPMN between 1994 and 2011 with documented postoperative abdominal imaging. We calculated time to recurrent disease as indicated by radiographic change and created a multivariable Cox proportional hazards model to assess the relationship between patient characteristics and histopathologic tumor features and disease recurrence.
  
  
  RESULTS
  Among patients with margin-negative resections and adequate imaging follow-up, we observed a recurrence rate of 13% over a median follow-up of 32.0 months. Individuals with invasive tumors on original pathology were more likely to recur (HR 5.2, 95% CI 2.2-12.2); however, original pathology did not predict disease severity on recurrence. Controlling for invasive pathology, no other histologic feature of the original tumor, including dysplasia at the surgical margin, predicted recurrence. Among non-invasive IPMN, pancreatitis was associated with disease recurrence (HR 3.6, 95% CI 1.2-10.7).
  
  
  CONCLUSIONS
  The frequency of recurrent disease in this population and the inability to predict recurrence argues for universal and continuous surveillance after resection for IPMN. The relationship between pancreatitis and disease recurrence should be investigated further.
authors.affiliation: Department of Surgery, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Winner
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.forename: Helen
authors.initials: H
authors.lastname: Remotti
authors.forename: James L
authors.initials: JL
authors.lastname: Lee
authors.forename: Beth A
authors.initials: BA
authors.lastname: Schrope
authors.forename: John A
authors.initials: JA
authors.lastname: Chabot
authors.forename: John D
authors.initials: JD
authors.lastname: Allendorf
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome